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APPLICATION FOR\SANITATION PERMIT Permit No. .-�Dz--7_____ (Complete in Duplicate) Date Issued_ Applica;-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.. -- � �- F` — ----- Owner's Name--------- ' +� � �' '� ---- Phone � } Address- Z ' r� --------- Contractor's Name Phone r= = Installation will serve--; Residen 5 Apartment House ❑ Commercial ❑ Tr iter Court ❑ Motel ❑ Other ❑ I 1 , - d xNumber of living units: __!.__-- Number of bedrooms A,"'Number of bats s ' Lot size ='r --------------------------------------- Water Supply:''Public, system ❑Community 'sysfem'.❑ Private ep to Water Table J. ft. .� Character:of soil to a Idepth of.3 fees t Sand ❑ Gravel ❑ Sandy Loam ❑ C1ay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction:~Yes: No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public s 1 e 'sAi4i a le within 200 feet.) ��-- - Se ti -Tank: Distance from nearest well__::aJ___ D'stanc fro f��u.n�ion__-_.1-C?-------__.Mater______ .______________________ _____________- No. of com artmerits_A--.-- -" Size---- - - --7--�.-.Liquid depth------- --------------Capacity--_ -4- p # D,is o al Field: Distance from nearest ell- ..Distance from foundation__-_-leg--'___Distance to nearest lot line_____.._.. 1 .,76 Number of lines-----------"--_-- -'-- Length of each line__------ LIZO---.-------Width of trench--------- --------------------- Type of filter material:------_. F_Depth of Vter�material____.___-___ _.Total length____47--el)----------- x _ ____________ Seepage Pit: Distance to nearest we .. '______Distance fmit rom fon o estance +o nearest l451R r� - � - Nurnb r°of p's#s ymafe isal_ lam et`er-�-^—� -------------- �' Cesspool: Distance fi om;'nearest well_F_ ._._-_ __Distance from oundafion............_-._..Lining materia!__. _______________ _____________ Size: Diameter---- _ .-- -Depth----------------- .�6 -�-- -�Liqui`d Capacity --gals..a - �- i Privy: Distance from nearest well__._-.._.__. ;_ ____ __ ______ _ __ __Distance.from'neayest'builcling T__-- ---------------------------- ------------ nearestlot line == -' ---------- --------•-----•--------------•---------------------------------- a eGn and/or Dettrin ntod R 9 pesEribe]:- --- ----'. . -a-� ------- --- -----' - --- ---------.-- -- --I hereb certif that I have .re ared th s a lication and that the wor e--- ----�---�---------- "`' ``� - ��- ........ -----. _ y y -prepared � PP 9 k will be done in acc¢rdance with� JoaquinCounty } ordinances, State laws, and rules and re ulations f he San Joaquin Local Health District. I� -L3--- --- (Owner and/or Contractor) (Signed.. ---- -- --------------------------------- - BBy: c --------------- -------------•-=- ---•-----------•----- ----- ;•----_-------------------------------------------- -------------{Title_----------•'---------I----•---•---•--•---------------- .... Plot plan, showing size of lot, location of system in c v - - ` -e ,--revue• ��P�' p grelation to wells, buildings, etc., can be placed on reverse side}: FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------- -•---------------- DATE--------------------------- - --------------------- BUILDING PERMIT ISSUEDQATE---- ------- -------------------------- #t REVIEWED BY------------------------ - ----------------------------------------------------------------------- BUILDING ; r recommendations----._%-------------------------- •--------- DATE---------_..A---•----------------•---- --------------- -------------------- ^y Alterations and/off o k ----- - ------- -----------------------------s----r----------••------�----''�°---••-----------------------------•--- .-�---- --,---t�'` r--, -- ,v?f r�-a.l - " __ ? ► ' ' -`'------- rlk__V ..�.� -......... LL� i' .. �j------ - �, --- .. ------------ _ • --° ------ " ------- --- = -- -- - -•----------- .----- ---------------- ---------------------------------------------------------------------------- '- d. L „i11!• '�-� �_��----'�.. -• Date J FINAL INSPECTIONi BY:. = = - ------- C ._. -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 614 North "C" Street i Stockton, California Lodi, California Manteca, California Tracy, California a ES-9-2M 1AS446 ATW09D 18-54 - ~